DOVER — Senate Republicans flexed their political muscle Wednesday, passing a $4.45 billion budget package and voting down each Democratic attempt to make changes.

The Senate, which holds a Republican majority, voted 19-5 along party lines Wednesday to pass its version of the budget, HB 1, and a trailer bill, HB 2, that contains several policy changes needed to implement the spending plan for the next biennium beginning July 1.

The Senate's budget contains less spending than the budget Gov. John Lynch proposed earlier this year, but $75 million more than the House budget. The total budget reaches about $10.3 billion once spending from federal and other non-state tax sources is included.

Since learning of the cuts included in the budget proposals from Lynch and the House, health care agencies around the state had braced for major cuts that would be coming down the line.

After the Senate passed the budget Wednesday, New Hampshire Hospital Association President Steve Ahnen expressed concern over the amount of cuts in payments to hospitals.

"Cutting over $250 million in payments to hospitals is unprecedented and simply too great a burden to bear for hospitals and the patients and communities who depend on them," he said.

He told Foster's Wednesday a frustration is hospitals will essentially be paying themselves to pay for Medicaid patients. Hospitals pay the Medicaid Enhancement Tax to help the state generate revenue to fund government and in turn receive uncompensated care payments for patients they treat who are uninsured or covered by Medicaid. Ahnen said the budget requires hospitals to now pay the tax and receive very little in return.

"Hospitals are in a sense losing that money that would have been used for uncompensated care," he said.

Sen. Lou D'Allesandro, D-Manchester, was among the Democratic senators vying for reinstatement of funds for certain state programs. He suggested during deliberations that the additional $30 million slated for the rainy day fund go toward uncompensated care, but the proposal was unpopular.

"The need is there, and they're (hospitals) going to have to deliver those services," D'Allesandro said Wednesday evening. "I thought we could use that money to spread around for uncompensated care because they're going to have to give care and they'll incur some significant debt. There was not a willingness to do that. There was no desire to alter the budget in any way."

Ahnen estimates hospitals will sustain losses of more than $126.9 million in 2011 and another $131.7 million in 2012.

"Just because the state is no longer paying for it doesn't mean those patients who come to the hospital and need care are going to stop coming," Ahnen said. "I think that's what the hope is: they'll continue to come and we'll continue to pay for it."

Ahnen said he anticipates hospitals will try to shift those costs onto patients with private insurance, so those premiums will increase. Hospitals will also face cuts to programs and staffing, he said.

In addition, cuts affecting other health care agencies around the state will likely drive more people to seek emergency room care; however, the Senate did restore some funds for mental health services for the developmentally disabled.

Cuts in state aid to the University System of New Hampshire were not restored — the Senate instead used the aid the House had designated for USNH to provide scholarships for private college students.

However, Senate Finance Committee Chairman Chuck Morse, R-Salem, has praised the budget for meeting the goals of living within the state's means, imposing no new taxes and fees and helping those most in need.

"Crafting this budget was a difficult task", said Morse, "but I'm proud to say Senate Finance rose to the occasion. This budget is designed to strengthen our state's fiscal situation for the next biennium as well as the future, but it is just a first step. We will continue to make reforms over the summer, into the fall and throughout the next legislative session. We will continue to hold the line on spending and look for additional savings."

Republican Party Chairman Jack Kimball also praised the budget efforts in a statement Wednesday.

"The result is a budget that doesn't raise taxes or fees and eliminates 150 million dollars in cost downshifting that Governor Lynch proposed in his budget," Kimball said.

The budget reflects an 11 percent decrease in spending from the last biennium and projects revenue growth of 1.3 percent and a surplus of about $30 million, according to a Senate statement.

That $30 million surplus would bring the state's rainy day fund to about $42 million.

The budget is now headed back to the House, and Senate Communications Director Carole Alfano said it will likely be headed for a committee of conference.

D'Allesandro, who voted against the budget in the Senate Finance Committee as well as on the Senate floor Wednesday, said he thought "it could do better" and hopes for positive changes to come out of deliberations in the committee of conference.